October 9, 2012 News

Telepractice: Research Trends

Telehealth Linked to Fewer Hospital Admissions

British researchers have found that telehealth helped patients with three diagnoses—diabetes, chronic obstructive pulmonary disease, and heart failure—avoid the need for emergency hospital care. The study, in the British Medical Journal, used a pragmatic, multisite, cluster randomized trial to assess the effect of home-based telehealth interventions on patients' use of secondary health care and mortality.

The telehealth involved remote exchange of data between 1,570 patients and health care professionals as part of patients' diagnosis and management. A control group (1,584 patients) received usual care.

A smaller proportion of telehealth users than controls were admitted to hospital during a 12-month follow-up. However, the magnitude of the group difference in admission proportion was relatively small (10.8%). Mortality at 12 months also was lower for intervention patients (4.6%) than for controls (8.3%). These differences in admissions and mortality remained significant after adjustment for baseline characteristics and for a predictive risk score.

Researchers indicate that the mechanism for the differences is not yet clear. Telehealth could help patients manage their conditions better and therefore reduce the incidence of acute exacerbations that need emergency admissions. Telehealth also could change people's perception of when they need to seek additional support, as well as professionals' referral or admission decisions. Further analyses will provide insights into how telehealth can lead to reductions in admission rates.

Remote Speech Evaluation Boosts Services to Patients With Cleft Palate

Remote speech assessment in patients with cleft lip/palate can increase access to care for underserved populations, according to a study in Annals of Plastic Surgery (doi: 10.1097/SAP.0b013e31823b6897).

Researchers explored whether remote speech evaluations could enhance the provision of long-term multidisciplinary care for cleft lip/palate provided by international humanitarian organizations that perform surgery across borders. They looked at whether a speech evaluation performed by a speech-language pathologist using telemedicine—between Tijuana, Mexico, and San Diego—would be equivalent to a speech evaluation performed in person. Spanish-speaking SLPs developed an informal protocol to evaluate several speech characteristics. Patients were simultaneously evaluated by two SLPs, one in Tijuana who evaluated patients in person, and the other over videoconference from San Diego. In addition, they administered a satisfaction survey to parents.

Results showed no statistically significant differences between the two methods of speech evaluation, particularly in oral muscle tone, resonance, lingual lateralization, oral pressure, and dentition. The survey showed family satisfaction with the speech evaluation performed using telemedicine.

Patients Get Comfortable with Tele-Assessment of Dysphagia

Patients are interested in and willing to receive dysphagia services remotely, according to a study in the International Journal of Speech-Language Pathology.

Researchers measured the perceptions of 40 patients with dysphagia before and after a telerehabilitation assessment session. The patients (median age of 66 years) completed pre- and post-session questionnaires that explored comfort with telerehabilitation, satisfaction with audio and video quality, benefits of telerehabilitation assessments, and preferred assessment modality. Patients' comfort was high in more than 80% of the group both pre- and post-assessment. Pre-assessment, patients were unsure what to expect with the auditory and visual aspects of the videoconference; they reported significant positive changes post-experience. Most patients believed in the value of remote services pre-session, a figure that increased to 90%–100% agreement post-session.

Although 92% felt they would be comfortable receiving services via telerehabilitation, 45% indicated ultimate preference for a traditional face-to-face assessment. Researchers note that although the data highlight that patients are interested in and willing to receive services via telerehabilitation, any concerns should be addressed pre-assessment.

Stakeholders Report Satisfaction With Online Auditory-Verbal Therapy

Parents and clinicians are satisfied and comfortable with remote delivery of auditory-verbal therapy (AVT) for children with hearing loss in Australia, according to a study in the Journal of Telemedicine and Telecare. A Brisbane clinic that provides AVT both in person and via computer-based videoconferencing surveyed parent and clinician satisfaction with the remote sessions. Five clinicians and 13 families completed questionnaires.

Parents and clinicians generally expressed high satisfaction in most sections of the questionnaire. All parents felt comfortable or as comfortable as face-to-face when discussing matters with the clinician online, and were satisfied or as satisfied as face-to-face with their level and their child's level of interaction/rapport with the clinician. All clinicians were satisfied or very satisfied with the telemedicine AVT program.


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